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Clin Obstet Gynecol. 2018 Jun;61(2):260-268. doi: 10.1097/GRF.0000000000000358.

Management of Menopausal Symptoms for Women Who Are at High Risk of Thrombosis.

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Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, Virginia.
Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina.


For women at elevated risk of thrombosis, clinicians are challenged to relieve menopausal symptoms without increasing the risk of thrombosis. Oral menopausal hormone therapy increases the risk of venous thromboembolism by 2-fold to 3-fold. Observational studies suggest less thrombotic risk with transdermal therapies and with progesterone over synthetic progestogens (progestins), but the data are limited. Beneficial nonpharmacologic therapies include cognitive behavioral therapy and clinical hypnosis, whereas beneficial nonhormonal pharmacologic therapies include selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. For treatment of the genitourinary syndrome of menopause, vaginal lubricants and moisturizers, low-dose vaginal estrogen, and intravaginal dehydroepiandrosterone are options.

[Indexed for MEDLINE]

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